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Old 06-06-2013
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Default Question regarding patient encounter !!

Hi all, I guess this is gonna be my last question before the match,my cs is in 6 days,I practiced all the cases once with a live partner in 10 days & really don't know what else to do.
anyway my question is , Is it ok to ask the sp questions regarding HPI , PMH , PSH ........ etc while I'm doing the physical ??
for example a case with DM , if I forget to ask about the last time he\she had eye exam , usually when I'm doing the physical & do the eye exam it hits me that I didn't ask about that so I go ahead & ask it.

is that ok ? & if it is how often can you do it because it actually saves time doing physical & taking Hx at the same time.
hope you get my point,thanks
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Old 06-06-2013
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another examples , you're checking the lower limbs for reflexes , then you realize you should've asked about gait disturbance , can you ask the sp while you're checking the reflexes ?

you're doing abdominal exam & you forgot to aski about radiation or quality or whatever ?

I'm listing some of the things that happened with me while practicing
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Old 06-06-2013
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Yeh. You can do that. It is always better to ask these questions during history taking but we are humans and we forget. So even if you ask relevant questions during the PE, it will be fine. The most important thing is that you mention whatever you ask on the patient note as SPs only grade you on PE, not on history taking.
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Old 06-06-2013
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thanks ,that actually makes sense , one more question since you took your test , when they say don't repeat painful maneuver does that mean don't touch that area again altogether ? or I can do a different test there?
for example RUQ tenderness & Murphy's , they involve the same area
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Old 06-06-2013
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Originally Posted by younissmed View Post
Hi all, I guess this is gonna be my last question before the match,my cs is in 6 days,I practiced all the cases once with a live partner in 10 days & really don't know what else to do.
anyway my question is , Is it ok to ask the sp questions regarding HPI , PMH , PSH ........ etc while I'm doing the physical ??
for example a case with DM , if I forget to ask about the last time he\she had eye exam , usually when I'm doing the physical & do the eye exam it hits me that I didn't ask about that so I go ahead & ask it.

is that ok ? & if it is how often can you do it because it actually saves time doing physical & taking Hx at the same time.
hope you get my point,thanks
It is absolutely OK to ask questions during PE. In fact you can do the history & PE in any order you want as long as you are in the room.
For example, you are doing closure and you realize that you missed a key part of PE ( e.g. otoscopy in a hearing loss case) you can still make some excuse and do the otoscopy. It won't look good but you won't lose the points for not doing a key PE. The SP checklist doesn't have a point for doing things in any particular order.
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Old 06-06-2013
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If you have to do it, you can start by apologizing first (for causing pain) and then say I know this next maneuver might be a little painful but I need to do it as it will help me in coming up with a diagnosis and treatment. You have to do it. but. End of the day, they are all actors and not in real pain. It can be for RUQ tenderness, Murphy, rebound tenderness.


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Originally Posted by younissmed View Post
thanks ,that actually makes sense , one more question since you took your test , when they say don't repeat painful maneuver does that mean don't touch that area again altogether ? or I can do a different test there?
for example RUQ tenderness & Murphy's , they involve the same area
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Old 06-06-2013
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If you have to do it, you can start by apologizing first (for causing pain) and then say I know this next maneuver might be a little painful but I need to do it as it will help me in coming up with a diagnosis and treatment. You have to do it. but. End of the day, they are all actors and not in real pain. It can be for RUQ tenderness, Murphy, rebound tenderness.
Thanks gagan , but what do you mean by " if " ,someone comes with a RUQ pain & the Hx suggest cholecystitis don't we " have to " do both murphy & regular palpation
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NEVER do it again at the same site.
However, if light palpation revealed tenderness (e.g. RUQ--> Cholecystitis) then you do the Murphy's and THEN say " I understand it caused you pain but it was necessary for me to reach an accurate diagnosis in order to provide you with the best treatment of your condition. I will not do it again.
The point is : Do everything necessary and then say "as above".
However, if Brudzinski's sign is positive don't do Kernig's----that will be taken as causing unnecessary pain.
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